a comparative study to assess the effectiveness of...

A COMPARATIVE STUDY TO ASSESS THE

EFFECTIVENESS OF SWISS BALL EXERCISE

OVER DRY LAND EXERCISES IN REDUCING

PAIN AND DISCOMFORT AT SPINAL

COLUMN FOR PRIMIPARA MOTHERS

REGISTER NUMBER: 27091211

A DISSERTATION SUBMITTED TO

THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY

CHENNAI

IN PARTIAL FULFILLMENT FOR THE

REQUIREMENT OF THE DEGREE IN

MASTER OF PHYSIOTHERAPY

APRIL – 2011






Head of the Institution: ______________________________

Principal: _________________________________________

Dr.R.SHANKER M.P.T. (OG)

TMMF, MADURAI



CHENNAI




APRIL – 2011






REGISTER NUMBER : 27091211

Guide: _____________________________________

Dr.R.SHANKER M.P.T. (OG)

TMMF, MADURAI



CHENNAI




APRIL – 2011






Examiners:_________________________________________

_______________________________________________________

REGISTER NUMBER : 27091211



CHENNAI




APRIL – 2011

CERTIFICATE

This is to certify that the project work entitled, “A COMPARATIVE

STUDY TO ASSESS THE EFFECTIVENESS OF SWISS BALL

EXERCISE OVER DRY LAND EXERCISES IN REDUCING PAIN

AND DISCOMFORT AT SPINAL COLUMN FOR PRIMIPARA

MOTHERS”, was done by M.VIDHYA DEVI a bonafide student of

Master of Physiotherapy under THE TAMIL NADU Dr. M.G.R. MEDICAL

UNIVERSITY, CHENNAI.

PROJECT GUIDE

(Prof. R.SHANKER, M.P.T. (OG.)

TMMF, MADURAI

ACKNOWLEDGEMENT

I first thank LORD and my parents for the confidence they have given

throughout my life. I humbly acknowledge all the love and care showed by

my parents throughout my life in making me what I am.

I respectively thank our correspondent Prof.K.R.ARUMUGAM for

his support and guidance for the successful completion of my project. I wish

to convey my sincere regards to Principal Dr.R.SHANKER M.P.T. (O.G.).

]

I gracefully recognize the valuable suggestions and guidance given by

my guide, Dr. R.SHANKER, M.P.T. (O.G.), Associate Professor. Ultra

College.

I am indebted to all the faculty member of physiotherapy department.

Dr.M. ANANTHA RAJ B.P.T.

Dr.J. SUDHARSAN M.P.T. (CARDIO)

Dr.B. RAMKUMAR M.P.T. (CARDIO)

I also thank librarian Mr.THIRUNAVUKKARASU and other library

staffs for extending cooperation in utilization of library.

I thank Prince Women’s Hostel, Ultra college, Madurai for

supporting the study. My heartful thanks to my seniors and friends.

CONTENTS

S.NO CONTENT Page No.

I INTRODUCTION 1-15

Need for the study 4

Statement of the problem 4

Objectives 4

Hypothesis 5

Null hypothesis 5

Operational definition 6

Assumption 6

Delimination 6

Anatomy 7 - 9

Physiology of pregnancy 10-15

II REVIEW OF LITERATURE 16-21

III METHODOLOGY 22-52

Research Design 22

Setting of the study 22

Population sampling 22

Samplying method 22

Criteria for selection 23

Scoring procedure 24-28

Data collection procedure 29-41

Data analysis 42-52

IV RESULTS 53

V DISCUSSION 54

VI CONCLUSION AND SUGGESTIONS 55

REFERANCE 56-57

APPENDIX –I 58-59

APPENDIX –II 60-62

1

INTRODUCTION

Pregnancy a single cell grows and develops into a human being

capable of independent existence. This process takes place over a period

of 40 weeks (9months). Prenatal development is the development of a

baby during the period before birth.

Prenatal development has three stages:

The period of zygote.

The period of the embryo.

The period of fetus.

During pregnancy women undergo many postural and

biomechanical changes during pregnancy as a result of having to

accommodate a growing baby. The spine will experience a forward

pulling as your centre of gravity shifts creating pain and discomfort at the

spinal growth.

The low back pain is one of the most frequent problems existing

throughout the world. The problem of back pain in pregnancy has

attracted attention of clinicians and researches from all over the world.

2

The exercise ball is an exercise treatment option for back

pain suffers and it designed to help to reduce low back pain .Exercise ball

or Swiss ball or physio ball help to strength core body muscle ,stabilize

the spine and enhanced proprioception.

This Swiss ball exercise provides the body with increased

balance and stability. It helps to reduce pain by stimulating the body to

produce increased amount of natural pain inhibitors.

Dry land exercise help to increase body temperature to rise

metabolism to provide energy. It help to improve strength and stability of

the core muscle.

Back pain in pregnant women is a very common complaint. In

fact as many as 80% of pregnant women will have back pain at some

time during their pregnancy. There are several types of back pain that

occur among expectant mothers, but low back pain is the most common.

Backache can occur for a number of reasons, which can be reduced to

two main issues: hormones and postural changes.

3

During pregnancy, your body produces a veritable cocktail of

hormones. Among these is a hormone called relaxing. The primary role

of relaxing is to loosen the joints and ligaments in your body in order to

help them stretch and widen. This allows your body to more easily make

room for your baby inside of your pelvis. And, when the time comes for

your baby to be born, the hormone relaxing will have helped the joints of

your pelvis relax and stretch enough for your baby's shoulders to pass

through your pelvic bones.

What does all that have to do with lower back pain? Well,

unfortunately, your body is unable to isolate which ligaments and joints

will stretch and loosen, and this happens on a broad scale throughout your

body. As the ligaments and muscles which normally support your spine

become lax, it can result in some instability in the spine, which can result

in aching and discomfort.

As your uterus expands and your baby grows, it also causes

immense changes in your posture, which can result in aching. As your

abdomen and uterus stretch, it puts a greater strain on your back muscles.

4

NEED FOR THE STUDY :

1. To reduce the pain and discomfort of the spinal column.

2. To explain the importance of dry land exercise in prenatal period.

3. To explain the importance of swiss ball l exercise in prenatal

period.

STATEMENT OF THE STUDY:

A comparative study to assess the effectiveness of

swiss ball exercise over dry land exercise in reduce pain and discomfort

at spinal column of primipara mothers before and after teaching exercise

programme.

OBJECTIVES:

To reduce the pain and discomfort of the spinal column for

primipara mothers.

To assess the effectiveness of swiss ball exercise over dry land

exercise.

5

HYPOTHESIS :

There is significant difference in reduce pain and discomfort of

the spinal column for primipara mothers after exercise with swiss

ball than dry land.

Experimental group mean the primipara mothers who are doing

exercise with swiss ball for reduce pain and discomfort of spinal

column.

Control group means the primipara mothers who are doing exercise

with dry land for reduce pain and discomfort of spinal column.

NULL HYPOTHESIS:

There is no significant change or difference in reduce pain and

discomfort of the spinal column for primipara mothers after

exercise with swiss ball than dry land

Experimental group mean the primipara mothers who are doing

exercise with swiss ball for reduce pain and discomfort of spinal

column.

Control group means the primipara mothers who are doing exercise

with dry land for reduce pain and discomfort of spinal column.

6

OPERATIONAL DEFINITION:

Prenatal development is the development of a baby during the

period before birth .

Prenatal development has three stages zygote, embryo, fetus.

Effectiveness of swiss ball exercise over dry land exercise in

reducing pain and discomfort at spinal column .

ASSUMPTION:

For reducing pain and discomfort at spinal column by swiss ball

exercise.

For reducing pain and discomfort at spinal column by dry land

exercise.

DELIMITATION :

Women who come for delivery in Meenakshi mission hospital

and Research centre, Madurai.

Women who are willing to participate in the exercise program.

7

ANATOMY OF FEMALE REPRODUCTIVE SYSTEM :

The female reproductive system is designed to carry out several

functions. It produces the female egg cells necessary for reproduction,

called the ova or oocytes. The system is designed to transport the ova to

the site of fertilization. Conception, the fertilization of an egg by a sperm,

normally occurs in the fallopian tubes.

The female reproductive anatomy includes internal and external

structures.

Labia majora: The labia majora enclose and protect the other

external reproductive organs. Literally translated as "large lips," the

labia majora are relatively large and fleshy, and are comparable to

the scrotum in males.

Labia minora: Literally translated as "small lips," the labia minora

can be very small or up to 2 inches wide.

Bartholin’s glands: These glands are located next to the vaginal

opening and produce a fluid (mucus) secretion.

Clitoris: The two labia minora meet at the clitoris, a small,

sensitive protrusion that is comparable to the penis in males.

8

Reproduction:

In the reproductive process, two kinds of sex cells or gametes are

involved. The male sperm, and the female egg or ovum. These two cells

meet in the female's reproductive system to create a new individual.

Vagina:

The vaginal wall is a thick, fibromusclar tube that forms the

inferior- most region of the female-reproductive tract and measures about

4 inches in length in an adult female. It connects the uterus with the

outside of the body anteromedially, and thus functions as a entry point for

the penis during sexual intercourse.

Cervix:

The cervix is situated between the vagina and the uterus. It mucous

membranes helps to either allow for the passage of sperm or the

obstruction of sperm.

9

Uterus:

This muscular organ is made up of three layers from deep to

superficial: endometrium, myometrium, perimetrium.

The Endometrium can be further divided into Stratum Basalis and

Stratum Functionalis which is the growth filled with blood and sluffed

out on the next menstartion.

Fallopian Tube :

The fallopian tubes extend superiolaterally off the uterus and

connects with the ovaries. These tubes have finger like projection's called

Fimbrae at the end of the tube near the ovary.

Ovaries:

Women have an ovary on each side of the uterus. Each month the

ovaries release an egg which is then fertilized or sloughed off. They also

produce estrogen and progesterone which help with reproductive

function.

10

PHYSIOLOGY OF PREGNANCY

Prenatal development :

Prenatal development is trhe development of a baby during the

period before birth. an ovum , a female cell or egg is released by one of a

women’s ovaries. the egg moves through the fallopian tube to the uterus,

duration is two or three days.

The union of an ovum and a sperm resulting in the beginning of

pregnancy this union is called zygote. Fertilization is the joining of a

sperm and an egg. A sperm is a male gamete that is released into the

vagina of a female during intercourse. In order for fertilization to occur

there must be a mature ovum present. Every month one of the ovaries

releases an egg which will meet one of the A 4 million sperm the male

ejaculates into the vagina.

Period of zygote:

The first stage is the development of a human baby is called the

period of zygote or fertilized egg. It lasts two weeks. Beginning of this

period, the embryo has developed to beginning of all organs and body

parts, the cells are now recognizable as a developing human arms , legs,

fingers and toes are developed.

11

The thickened lining of uterus provides both a warm and soft bed

and food for the fertilized egg. It grows by a process called cell division

.This single , complete cell divides and becomes two. Two cells become

four and so on , until the mass of cells. The end of two weeks , the

zygote is still only the size of a pinhead.

Period of embryo:

Second stage of pregnancy is the period of embryo . The embryo is

the developing cluster of cells in the uterus during about the third through

eight weeks of pregnancy.The tissue around the unborn baby to the

mothers uterus, has developed . The umbilical cord , a long tube that

connects the placentas to the unborn baby developed. Nourishment and

oxygen from mothers blood stream are carried from the placenta to the

developing baby through the umbilical cord.

Period of fetus:

The third and last stage of pregnancy beging about the eighth or

ninth week lasts until birth. This stage is called the fetal period, the period

of fetus , unborn baby from about the eighth or ninth week of pregnancy.

The beginning of all organs and body parts.

12

The cells are now recognizable as a developing human .

The fetus heart beat can usually be heard before movement is felt. This

chapter we will discuss the topics covering pregnancy, from conception

to birth. The chapter will cover fertilization, implantation of the zygote, to

becoming a fetus, the three trimesters, and the progressive development

of the fetus through the weeks of pregnancy. It will cover the topic of

birth and different birthing methods.

IMPLANTATION

The blast cyst preserves itself by secreting a hormone that

indirectly stops menstruation. The trophoblast cells secrete hCG

hormones that help maintain the corpus luteum that would

normally regress. In turn, the corpus luteum continues to secrete

progesterone, which maintains the endometrium of the uterus in the

secretory phase. This helps the blastocyst to continue to grow and

stay embedded within the endometrium. The embryoblast within

the blastocyst forms 3 primary germs layers: ectoderm, mesoderm,

and endoderm.

13

EMBROYNIC DEVELOPMENT OF SPECIFIC STAGES

First Trimester

An embryo this tiny shows very distinct anatomic features, including

tail, limb buds, heart (which actually protrudes from the chest), eye cups,

cornea/lens, brain, and prominent segmentation into somites. The

gestational sac is surrounded by a myriad of chorionic villi resembling

elongate party balloons.

4 Weeks

There are only the beginnings of facial features. All the major

organs are starting to form. Gill-like folds that develop into facial

features, beginnings of the spinal cord, skin is translucent, and

rudimentary (basic; minimal) heart develops.

6 Weeks

The length from crown to rump is about the size of a finger tip, ¾

". The beginnings of all the major organs will have formed.

14

9 Weeks

The length from crown to rump approximately 1 1/4". The facial

features are becoming more distinct, and the “tail” has disappeared.

The muscles are also developing. Eyes are formed but eyelids are

still closed over them.

Heart- is now a four-chambered and fully formed organ; it beats

about 180 times per minute.

12 Weeks

At twelve weeks the fetus looks like a tiny human. It is about 2

1/2" long and weighs 1/2 oz. Arms and legs are now beginning to

move. Skin is red and translucent.

Second Trimester

20 Weeks

By 20 weeks the fetus will be about 6 1/3" long and weighs 12 oz.

Movements are for more coordinated.

The sexual organs are well developed and are usually visible on

ultra sound.

The fetus is growing very quickly.

At this stage, the mother should feel the movements of the fetus.

15

Third Trimester

29 Weeks

By 29 weeks the baby is about 10" long and weighs about 2 lbs. 7

oz.

The brain grows much larger, and fatty protective sheath covers the

nerve fibers; this important development allows brain impulses to

travel faster, enhancing the ability to learn. The lungs have

developed most of their airways and air sacs.

40 Weeks

The baby is now ready to be born. When the head of the baby

moves down from high in the mother's abdomen and settles deeper

into her pelvis in preparation for birth, it is called engagement. This

can happen any time between 36 weeks and labor.

In the last four weeks of pregnancy the baby puts on a lot of weight

and develops a thick layer of fat. All organs are completely formed

and functioning.

16

REVIEW OF LITERATURE:

1. The book Moving Through Pregnancy: the Complete Exercise

Guide for Today's Woman by Elisabeth D Bing

This (author) is published or distributed by Bobbs-Merrill Co

2. Stability Ball Exercises - Physical Fitness Fun

Mar 26, 2009 Karen Stephenson

Swiss balls, or more commonly referred to as stability balls, are not

new. This 50 year old invention is still gaining popularity among

those who want to get fit.

3. Reduction of back and posterior pelvic pain in pregnancy.

Spine. 1994; 19:894-900. Ostgaard HC, Zetherstrom G, Roos-

Hansson E, Svanberg B. Posterior pelvic pain (PPP) is pain felt at

or near the sacroiliac joints of your pelvis as a result of sacroiliac

joint dysfunction.

http://www.suite101.com/profile.cfm/karenanne24

17

4. REVIEW BRITISH COLUMBIA MEDICAL JOURNAL

JULY 2006

Fit to deliver: an innovative prenatal and postpartum

fitness program. By karen nordahl, md, carl petersen bpe,

bsc(pt), and renee jeffreys, msc. Vancouver: hartley &

marks publishers inc., 2005. Isbn 0-88179-208-x.

Paperback,163 pages.

This book is written by a physician, a physical therapist, and

an exercise physiologist. The stated goal of the book is to “give

women the ability to modify their existing fitness program (or, for

those new to exercise, to start a program) and to go one step further

by offering state-of-the-art training techniques to better prepare for

delivery and the postpartum period.”

5. FIT TO DELIVER REVIEWED BY: ROBYN

CHURCHILL, CNM, MSN

Fit to Deliver by Karen Nordahl, Renee Jeffreys, and Carl

Petersen is a complete guide to maintaining fitness throughout

pregnancy. Written by a Canadian physician, an exercise

physiologist, and a physical therapist, this book is atimely addition

to the layperson’s literature on pregnancy. As our society faces

increasing obesity rates and decreasing activity levels among all

18

ages, addressing questions about how to safely exercise is a public

health mandate.

6. DR. KARIN KAUSKY MD

This book covers it all; prenatal and postpartum, beginner to

advanced, cardio, strength training, core stability, as well as

explaining all of the normal physiologic changes in a woman's body

throughout pregnancy. Very concise and easy to read with lots of

accompanying photograghs.

7. CONTACT MAGAZINE

Carl Petersen (Vancouver, BC) teamed up with Karen

Nordahl (MD) and Susi Kerr (personal trainer) to co-author and self

publish the book, "Fit to Deliver," outlining an exercise program for

expecting and new mothers and their babies

8. Exercise and Pregnancy

CANOE.CA FITWISE BY KAREN TANKARD

You're more likely than ever before to run into a pregnant

woman engaged in exercise, especially if you're a gym member.

19

That's because many fitness facilities are developing specialized

exercise programs with expectant moms in mind.

9. The Pregnancy Exercise Book by Barbara Dale

This (author) is published or distributed by Pantheon

[039471119X, 9780394711195]. This particular edition was

published on or around 1982-10-12 date. The Pregnancy Exercise

Book has Paperback binding and this format has 128 number of

pages of content for use.

10. The book Pregnancy Exercise by Judy Difiore

This (author) is published or distributed by Carroll & Brown

This particular edition was published on or around 2006-06-30 date.

Pregnancy Exercise has Paperback binding and this format has 74

number of pages of content for use. This book by Judy Difiore is

written in English language.

11. The book Exercising Through Your Pregnancy by James F

Clapp, M D Clapp Iii

This (author) is published or distributed by Addicus Books .

This particular edition was published on or around 2002-01-31 date.

20

Exercising Through Your Pregnancy has Paperback binding and this

format has 256 number of pages of content for use. This book by

James F Clapp, M D Clapp Iii is written in English language.

12. Times New Roman By: Thomas E. Hyde, DC

These exercise balls are constructed of elastic, soft polyvinyl

chloride (PVC) and diameters range between 35 – 85cm (14-34”).

Most balls are made to take approximately 320 kilograms ( about

700lbs). They are used in the fitness industry as well as in physical

therapy Core Body Strength Exercises

13. Beginning Exercise Program on an Exercise Ball By: J. Talbot

Sellers, DO

Beginning an exercise program with an exercise ball should

begin with stretches and learning simple exercise ball routines.

14. Margaret Polden and Jill Mantle :

Physiotherapy in Obstetrics and Gynacology, 1994.

Pregnancy a single cell grows and develops into a human being

capable of independent existence. This process takes place over a

period of 40 weeks (9months). Prenatal development is the

development of a baby during the period before birth.

21

15. Jill Mantle , Jeanette Haslam, Sue Barton :

Physiotherapy in Obstetrics and Gynacology, 1994.

Pregnancy a single cell grows and develops into a human being capable

of independent existence. This process takes place over a period of 40

weeks (9months). Prenatal development is the development of a baby

during the period before birth.

22

RESEARCH METHODOLOGY:

RESEARCH DESIGN:

An experimental pre test, post test and control group research design

was chosen to study and to determine the effectiveness of swiss ball

exercise for reduce pain and discomfort of spinal column.

An experimental pre test, post test and control group research design

was chosen to study and to determine the effectiveness of dry land

exercise for reduce pain and discomfort of spinal column.

Setting of the study :

This study was conducted in antenatal period in Meenakshi mission

hospital and research centre, Madurai.

Population sample:

The sample of 40 prenatal women were divided into two groups .

10 - Experimental Group.

10 - Control Group.

Sampling method :

Systemic random sampling was done in antenatal wards and every

women pregnant for the first time was selected for the study.

23

Inclusion criteria :

Second trimester of pregnancy .

Age less than 30 years .

Primipara mothers .

Willing to comply with study protocol.

Exclusion criteria:

Bleeding or spotting .

Low placenta .

Threated or recurrent miscarriage.

Previous premature birth .

Weak cervix.

VARIABLE OF THE STUDY :

DEPENDENT VARIABLE :

Pain .

IN DEPENDENT VARIABLE :

Swiss ball exercise.

Dry land exercise.

MATERIAL USED :

Swiss ball .

24

METHODOLOGY :

PRE TEST SCORE :

The pre test score for measuring pain is taken with the help of

visual analogue scale.

DATA COLLECTION PROCEDURE :

Pilot study was done was done with six subjects after which the

study was conducted by fixing validity and reliability criteria.

VISUAL ANALOGUE SCALE

Definition:

Pain is defined pain as an unpleasant sensory and emotional

experience associated with actual or potential tissue damage or described

in terms of such damage, according to The International Association for

the Study of Pain. It is useful to distinguish between two basic types of

pain, acute and chronic, and they differ greatly.

The visual analogue scale is the patients psychological

measurement of pain . It consists of an unmarked straight line having two

ends . One end indicating no pain and other with maximum pain and the

other with minimum pain. The subject were instructed to make a mark on

the 10 cm bon segmental horizontal line which represents the level of

pain at the time of test .

25

Then the distance from the left end to the subjects mark was

measured in centimeters and recorded .This numerical index of the

severity of pain was used as the score. Instruct the patient to point to the

position on the line between the faces to indicate how much pain they are

currently feeling. The far left end indicates ‘No pain’ and the far right

end indicates

‘Worst pain ever’.

26

2. QUESTIONARRE SCALE:

This method of data collection is quite popular, particularly in case

o f big enquiries. It is being adopted by private individuals, research

workers, private and public organisation and even by governments . in

this method a questionnaire is sent to the persons concerned with a

request to answer the questions and return the questionnaire. A

questionnaire consists of a number of questions printed or typed in a

definite order on a form or set of forms.

Questions may be dichotomous (yes or no answers) , multiple choice

(alternative answers listed ) or open ended. The later type of questions

are often difficult to analyse and hence should be avoided in a

questionnaire to extent possible. There often difficult to analyse and

hence should avoided in questionnaire which indicate the reliability of the

responds.

The questions are presented with exactly the same wording and in

same responds. The form of question may be stated in advance and not

constructed during questioning. Structured questions may have alternative

questions is one in which all questions and answers are specified and

comments in the respondents own words are held to the minimum. when

these characteristic are not present in a questionnaire, it can be termed as

unstructured or non structured questionnaire.

27

Answer the following questions :

1. How you feel during breathing .

A, bad -0 b, good -1 c, better -2

2. How you feel during squating .


3. How you feel during walking .


4. How you feel during cross leg sitting .


5. How you feel during lying on supine .


28

6. How you feel during prolonged standing .


7. How you feel during stair claimbing .


8. How you feel during turning over .


9. How you feel during passing urine .


10. How you feel during washing .

A, bad -0 b, good -1 c, better -2.

29

SWISS BALL EXERCISES

SIT ON THE BALL

Sit on the ball with your feet flat on the floor about hip-width apart.

Allow the arms to relax at your sides,

then slowly raise them and outstretch the fingerstips toward the

ceiling.

Slowly lower them to the starting position. This exercise help to

tone arm, stomach and core muscle.

The abdominal core musclesv play an important role in carrying

certain body function . strong abdominal muscles means strong

digestive system and improved metabolism. Simply sitting on it can

improve your posture, balance and even strengthen stomach muscles.

30

BOUNCE ON THE BALL

Sit on the ball.

Bounce on the ball.

If possible rotate their hips in a circle.

While in a sitting position, try rhythmically bouncing on the ball to

strengthen leg and abdominal muscles (use caution so you don't fall off!).

Some women will also rotate their hips in a circle while sitting on the ball

to strengthen abdominal muscles.

31

LUNGE EXERCISE

Place the ball against a wall and then place the small of your back

against the wall.

Stand with your legs spaced a little further than your hips.

Extend your left knee (so you're lunging) and hold for 5-10

seconds.

Return to the start position and then do the same with the right

knee.

Do this for 12-15 reps.

You could also sit on the ball, with the pelvis tilted back and do the

same exercise to strengthen leg muscles and improve balance.

32

BACK EXTENSION WITH BALL EXERCISE:

To perfom the back extension with ball, lie with the head facing

downwards.

The exercise should be positioned beneath the body (hips)

Then lift the torso upwards.

The hands to be straighten out at side.

It is good for core and abdominal muscles.

33

WALL SQUATING EXERCISE:

Place your exercise ball between the wall and the small of your

back. Make sure you can just see the tips of your toes when you

look down.

Slowly sit down into a squat. As you squat,

Remember that you should be able to wiggle your toes because all

your weight should be in your heels.Strength thigh and buttocks

muscle.

34

CHOSSING A BIRTHING BALL

When using a birthing or exercise ball during pregnancy, you'll want

to choose the right one. Make sure that whatever ball you choose is burst

resistant. This means that if it gets a hole in it, it'll slowly deflate rather

than popping. You'll also want to choose a ball based on your height. In

general, women under 5 feet, 2 inches will be most comfortable on a 55

cm ball. Taller women (over 5 feet 10 inches) will probably prefer a 75

cm ball. Everyone else will like a 65 cm ball. Always inflate or deflate

the ball so that your knees are directly over your feet and at a 90 degree

angle.

Safety Precautions

Always check in with your doctor before starting an exercise

regime during pregnancy. When doing exercise ball workouts during

pregnancy caution--your center of gravity is not the same and it is

possible to fall of the ball and injure yourself. If you've never sat on an

execise ball, have someone help you the first few times you try it untl you

become comfortable.

Use your ball on a stable surface away from sharp objects. In

addition, make sure your feet are bare or you're wearing non-slip shoes

when doing birthing ball exercises to prevent injures.

35

Effects of Swiss ball exercise :

The information in this article should not be considered medical

advice. The information in this article is not meant to treat, diagnose,

prescribe or cure any ailment. Always check with your physician before

taking any products or following any advice you have read on

Always consult your doctor before you start, stop or change anything that

has been previously prescribed. Certain herbs and holistic remedies are

unsuitable to take Strengthening your core muscles (abs, back, and pelvic

floor) is important for sustaining a healthy pregnancy and successful

labor.

Besides helping you push during childbirth, these muscles also

maintain good posture, which can alleviate backaches and sciatica

commonly associated with the later stages of pregnancy.

Some examples of strengthening exercises from the fitness experts

at Ball Dynamics International, creators of FitBALL, to help you

throughout all phases of your pregnancy: Here are some examples of

strengthening exercises from the fitness experts at Ball Dynamics

International, creators of FitBALL, to help you throughout all phases of

your pregnancy:

36

DRY LAND EXERCISE :

1.TAILOR SITTING

Sit on the floor and bring your left foot towards you so it touches

your body .

Bring the right foot but do not cross your ankles .

Lean forward slowly until your knees touch the floor.sit this way,

Back straight , knees almost touching the floor for a few minutes

several times

A day .this exercise should be started early in pregnancy .

The exercise helps to condition muscle of the inner thigh and

pelvic floor that should be flexible during delivery of your baby . it also

releases tension in the upper back .

37

2.PELVIC TILT

Lie on your back with knees bent.

Inhale through your nose and tighten your stomach and buttock

muscles .

Flatten the small of your back against the floor and allow your

pelvis to tilt upward .

Hold for a count of five as your exhale slowly .

Relax , repeat.

This exercise is very important because it is the building block of

good posture , Strengthens your abdominal and back muscles, and

therefore decreases back strain and fatigue .

38

3.KEGELS EXERCISE :

Squeeze the pubococcygeal muscle for five seconds .relax for five

seconds, then squeeze again . at first do 10, five –second squeezes,

three times a day.

Flutter exercise : squeeze and release, then squeeze and release as

quikly as you can.

Work up to doing 100 kegels each day.

Kegel exercise tone the pubococcygeal muscle. This is the muscle

use to stop and start the flow of urine. Exercising this muscle helps

prevent hemorrhoids, supports your growing baby. Assists during

and after labor, keeps the muscle of vagina toned, and sexual

pleasure for both.

Learn to isolated this muscle by stopping the flow of urine a few

times. Use this technique only to locate the muscle. Do not exercise the

muscle this way as it may lead to urinary tract infection. Another way to

locate the muscle is to put clean finger in the opening of vagina and

tighten .

39

Kegel exercises help strengthen the muscles that support the

bladder, uterus, and bowels. By strengthening these muscles during your

pregnancy, you can develop the ability to relax and control the muscles in

preparation for labor and birth. Kegel exercises are also highly

recommended during the postpartum period to promote the healing of

perineal tissues, increase the strength of the pelvic floor muscles and help

these muscles return to a healthy state, and also increase urinary control.

While doing Kegel exercises, try not to move your leg, buttock, or

abdominal muscles.

4.SQUATTING EXERCISE :

Move to the squatting position; knees over toes.

Keep heels on the floor; feel the stretch in the back of your

thighs.

Hold for 20 to 30 seconds , gradually increase the time to 60

to 90 seconds.

Relax head and arms throughout this exercise.

This a good exercise to prepare for squatting during the

pushing stage of labor.

40

5. PELVIC ROCKING EXERCISE :

This exercise stretch the upper back muscles.

Get on hands and knees with your hands directly under your

shoulders and knees under hips

Inhale deeply

Slowly ehale while pulling the abdomen in and tightening the

buttocks so your whole spine curls into a C . at the same time

tighten the pelvic floor muscles.

Relax, but keep your bank straight.

Repeat these steps eight times.

41

DATA ANALYSIS :

Statistical method used in this study was frequency, percentage,

distribution, Mean, Standard deviation, Paired t test.

42

OBSERVATION AND DATA ANALYSIS

The separate perform was used to record the pre and post

intervention score for each subject.

The dates collected were analyzed using these formulas.

PAIRED ‘T’ TEST

Mean

=

Standard Deviation (SD)

=

Standard Error (SE)

=

Paired ‘t’ test

=

INDEPENDENT ‘T’ TEST

Standard Deviation (S)

=

Standard Error (SE)

=

‘t’ critical value

=

43

TABLE I

DISTRIBUTION OF MEAN AND STANDARD

DEVIATION FOR GROUP I AND GROUP II USING

QUESTIONARY SCALE

Group I Group II

Pre test Post test Pre test Post test

Variable Mean SD Mean SD Mean SD Mean SD

Pain and

discomfort

5.8

1.98

19

5.58

7.3

2.60

26.1

2.21

44

TABLE I:

DISTRIBUTION OF MEAN AND STANDARD

DEVIATION

FOR GROUP I AND GROUP II USING

QUESTIONARY SCALE

45

TABLE II

OBSERVED CRITICAL RATIO VALUES FOR PAIRED

TESTS IN TWO GROUPS FOR PAIN AND DISCOMFORT

Groups

variable

T calculated

value

result

Group I

Dry land

exercise

Pain and

discomfort

6.72

significant

Group II

Swiss ball

exercise

Pain and

discomfort

10.82

significant

T table value = 2.262

This is significant at .05 level.

46

TABLE II


TESTS IN TWO GROUPS FOR PAIN

47

TABLE III

OBSERVED CRITICAL RATIO VALUES FOR

INDEPENDENT TESTS IN TWO GROUPS FOR PAIN

VARIABLE

t

CALCULATED

VALUE

t

TABLE

VALUE

RESULT

PAIN AND

DISCOMFORT

3.81

2.101

SIGNIFICAT

This is significant at 0.5 level .

48

TABLE I

DISTRIBUTION OF MEAN AND STANDARD DEVIATION


VISUAL ANALAGUE SCALE

Group I Group II

Pre test Post test Pre test Post test

Variable Mean SD Mean SD Mean SD Mean SD

pain

7.5

1.5

4.5

1.5

8.7

1.1

1.1

0.83

49

TABLE I

DISTRIBUTION OF MEAN AND STANDARD DEVIATION


VISUAL ANALAGUE SCALE

50

TABLE II


TESTS IN TWO GROUPS FOR PAIN AND DISCOMFORT

Groups

variable

T calculated

value

result

Group I

Dry land exercise

Pain and

discomfort

13.6

significant

Group II

Swiss ball exercise

Pain and

discomfort

17.67

significant

T table value = 2.262

This is significant at .05 level.

51

TABLE II


TESTS IN TWO GROUPS FOR PAIN AND

DISCOMFORT

52

TABLE III

OBSERVED CRITICAL RATIO VALUES FOR

INDEPENDENT TESTS IN TWO GROUPS FOR PAIN

VARIABLE

t

CALCULATED

VALUE

t

TABLE

VALUE

RESULT

PAIN AND

DISCOMFORT

6.29

2.101

SIGNIFICAT

This is significant 0.5 level .

53

RESULTS :

The result of the study supports the hypothesis . In Experimental

group the prenatal women showed significant different in reduce pain

and discomfort at spinal column.

The control group t value is 6.72, the experimental t value is 10.83

by using questionary scle. The calculated t value is 3.81.

The control group t value is 13.6, the experimental t value is 17.76

by using questionary scle. Then the calculated t value is 6.29.

The questionary scale and visual analyse results shows that

experimental group people get reduce pain and discomfort more in

control group.

54

DISCUSSION :

The result of the study supports the hypothesis . In Experimental group

the prenatal women showed significant different in reduce pain and

discomfort at spinal column.

It has also influence the practice of prenatal women of

experimental group and control group . thus the result supports the

hypothesis.

The pain reduce programme not only aims the physical being but

also mental well being . prenatal women may experience stress, pain and

discomfort during pregnancy due to various factors.

Swiss ball exercise help to reduce pain and discomfort at spinal

column than dry land exercise .

The result of VISUAL ANALOGUE SCALE and

QUESTIONARY SCALE support the hypothesis.

All the above results showed the importance of the swiss ball

exercise help to reduce pain and discomfort at spinal column than dry

land exercise .

55

CONCLUSION AND SUGGESTION :

Pain and discomfort at spinal column reduced by swiss ball exercise

than dry land exercise for primipara mothers.

All the above results showed the importance of the swiss ball

exercise help to reduce pain and discomfort at spinal column than dry

land exercise .

56

REFERENCES

1. Margaret polden and Jill mantle, “Physiotherapy in obstetrics and

Gynaecology”, 1994, India, Jay pee Brothers Medical Publishers,

Pages 306 – 307.

2. Alicia M, Weissman et al, “Natural history of Primary

Dysmenorrhoea: a logitudinal study”, British Journal of Obstetrics

and Gynaecology 2004, Vol:III PP. 345 -352.

3. Carolyn Kisher, Lynn Attencolby, “Therapeutic Exercises

foundation and Techniques”, Third Edition, Jaypee Brothers.

4. Rose mary E. Bailey, Jone Grayshon’ “Obstetrics and

Gynaecological nursing”, ELBS 3rd

edition

5. William D Mcardle Frank, Katch, Victor Katch, “Exercise

physiotherapy”, 4th edition, William and Wilkins.

6. John. W.W. Studd, “Progress in Obstetrics and gynaecology”,

Vol.15, Churchill Livingstone.

7. Bhasker Rao K, Roy Chowdhury N N, “Clinical Gynaecology”,

Orient Longman, 3rd

Edition.

8. Alan H Decherney, Martin L Pernoll, Lauren Nathan, “Current

Obstetrics and Gynaecologic Diagnosis and treatment”, 9th edition,

Mc Graw-Hill Professional 2002, page 626.

57

9. Kenneth J Ryan Kistener’s, “Gynaecology and Women’s health”,

7th

edition 2001. Pages 266-67.

10. Chanty Banikarim M D, Mariam R, Chacko M D, Stene H,

Kelder, “Prevalence and impact of Dysmenorrhoea on Hispanic

female adolescence”, Archives of Pediatric Adolescent Medicine

2000, Issue: 154, Pages 1226-1229.

11. Aganoff J A, Boyle G J, “Journal of Psychosomatic Research”,

Issue 38, pages 183-192, 1994.

12. Scott Ransom, Julie modenhauer, “Premenstrual Syndrome:

Systematic Diagnosis and individualized therapy”, Vol.26, No.4,

April 1998.

13. Dawn C S (1994) , “Text book of Gynaecology”, Calcutta, S. M.

Arabi dawn.

14. Lemos D, “The effects of aerobic training on women who suffer

from premenstrual syndrome”, dissertation abstract int 1991,

52:563

58

APPENDIX -I

PRENATAL ASSESSMENT REGARDING DRY LAND

EXERCISEAND SWISS BALL EXERCISE FOR PRIMIPARA

MOTHERS.

SECTION -A

Hospital Reg. No

Date:

Name

Age

Education address

Which Trimester

Relevant medical history

Previous level of activity

Prenatal complication

Any back pain

Any discomfort

Any postural deviation

Review date

59

Pain scoring by Visual Analogous scale after exercise:

Pain scoring by Severity scale after exercise:

Problem List –

Physiotherapy Management:

Short Term Goals:

Long Term Goals:

Declaration

I am willing to participate in this dissertation work conducted at

Meenakshi mission hospital and research centre, Madurai.

Doctors signature Signature of patient

60

APPENDIX –II

STRUCTED TEACHING PROGRAMME

Introduction

The exercise ball is an exercise treatment option for back pain

suffers and it designed to help to reduce low back pain.Exercise ball or

swiss ball or physio ball help to strength core body muscle,stabilize the

spine and enhanced proprioception provides the body with increased

balance and stability. It help to reduce pain by stimulating the body to

produce increased amount of natural pain inhibitors.

Effects of Exercise:

Weight within healthy range.

Improves balance posture and co-ordination.

Increase strength and stamina.

Reduce minor ailments of pregnancy.

Helps post partum recovery faster.

Better preparation for labour and delivery.

61

The information in this article should not be considered medical

advice. The information in this article is not meant to treat, diagnose,

prescribe or cure any ailment. Always check with your physician before

taking any products or following any advice you have read on

Always consult your doctor before you start, stop or change anything that

has been previously prescribed. Certain herbs and holistic remedies are

unsuitable to take Strengthening your core muscles (abs, back, and pelvic

floor) is important for sustaining a healthy pregnancy and successful

labor.

Besides helping you push during childbirth, these muscles also

maintain good posture, which can alleviate backaches and sciatica

commonly associated with the later stages of pregnancy.

Here are some examples of strengthening exercises from the

fitness experts at Ball Dynamics International, creators of FitBALL, to

help you throughout all phases of your pregnancy: Here are some

examples of strengthening exercises from the fitness experts at Ball

Dynamics International, creators of FitBALL, to help you throughout all

phases of your pregnancy:

62

CORE STABILTY is compromised during during pregnancy due to

Postural maladation because of increasing weight of foetus and

uterus.

Hormonal causes.

A large majority of pregnant population as much as 80 – 90 %

will develop diastasis by their final trimester which can flare of if

other conditions co- exist

Unless pregnancy and post partura women learn to exercise and

use their abdominal muscle correctly, these complaints might plague

their pregnancy and expended recoveries.

The missing link to abdominal strength and core integretity

during pregnancy,post parturn recovery,is to recruit core muscles

In this presentation we will provide basic information regarding

use of swissball (size,shape,texture,pressure )and important points to

be kept in mind while during swiss ball.

a comparative study to assess the effectiveness of...

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